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PL��MIT APPLICATI�,J <br /> CITY OF EVERETT PERMIT SERVICES <br /> 3200 CEDAR STREET, EVERETT, WA 98201 <br /> 425-257-8810— FAX 425-257-8857 <br /> SITE ADDRESS PARCEL TAX I.D.# PERMI7 x � <br /> 2 l s'� � �l-e I —�D3 <br /> LEGA LOT N . BLOCK TRACT <br /> DESC. <br /> OWNER A�DRESS ZIP PHONE <br /> J ru� T� �JqetY Z-2. .S�/f� �,�-- <br /> TENANT NAME I CONTACT NAME ����v� �,�2�N PHONE <br /> z��G 7 2 3 I.3 �' 2 -, <br /> CONTRACTOR Ap DRESS ZIP CONTR,LICENSE N <br /> otiT�G�- �'�K e- rn�r�3� �<�r- d �Sll�S /NG . <br /> ccpwl� d 6,�yr_cr-�997 <br /> PHOZO� 7Z3 l3 92 S7�Y S• Lc�c�[ E s'T' sL-'H'n'c.L <br /> c,�} 9t� /I J <br /> PRO�OSED USE OF BUILDING Building D Mechanical Addition I{EAT SOURCE <br /> PERMIT R Cambineti0n I ) PlUmbing WORK �Alteration Electric <br /> TYPE D Demolition � Sign � TYPE New Gas <br /> U Sprinkfer RepaiNMaint. Other <br /> CONTRACT PRICE OF WORK CITY OF EVERETT LOCAL SALES TAX COOE IS 3105 <br /> WORK OESCRIPTION <br /> �ir� � ��pressi� � sys�e�,.�, i�S�F�-,ll�. �-i'o� <br /> C C(n� �cGi eH LCoOc� ) <br /> PLUMBING MECHANICAL <br /> NO. TYPE OF Fl%TURE OR REM NO. TYPE OF flXTURE OR ITEM � <br /> _ WATER CLOSET _ A/C—A/HANDLING UNITS I <br /> _ BATHTUB _ FORCED AIR SYSTEMS I <br /> � _ LAVATORY(WASH BASIN) _ HEAT PUMP <br /> _ SHOWER _ UNIT HEATERS <br /> _ KITCHEN SINK 8 DISPOSAL _ CLOTHES DRYER <br /> _ DISHWASHER _ RANGE HOOD <br /> _ LAUNDFY TRAY WATER HEATEF <br /> _ CLOTHES WASHER _ METAL FIREPLACE/STOVE <br /> _ URINAL _ FIREPLACE INSERT <br /> _ DRINKING FOUNTAIN _ GAS FIREPLACE <br /> ; _ FLOOR DRAIN _ GAS RANGE <br /> _ BACKFLOW PREVENTER _ GAS PIPING <br /> _ SINK (SERVICE/BAR/MOP/ETC.) _ EXHAUST FAN <br /> _ OTHER _ OTHER <br /> _ -- - P�-�� <br /> '; I NEREBY CERITIFY THAT I HAVE READ AND EXAMINED THIS APPUCATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL <br /> � PROVISIONS OF LAWS AND ORID�NACES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHEfl SPECIFIED HEREIN OR <br /> � NOT. 7HE GRANTING OF A PERMIT DOES NOT PRESUMF TO GIVE AUTHORITY TO VIOLP,TE OR CANCEL THE PROVISION OF ANY OTHER <br /> STATE OR LOCAL LAW REGULATING CONSTRUCTION OR THE PERFORMANCE OF CONSTRUCTION. THAT I AM AUTHORIZED BY THE <br /> � OWNER OF THIS PROPERTY TO PERFORM THE WORK FOR WHICH APPLICATION IS MAOE AND i COMPLY WITH THE STATE <br /> . CONTRACTORS LAW 18.27 RCW AND 296.200 WAC. <br /> ; !zl/Q C/(.2 Q VL7-�'�� O 8�d�� 2 � I�� <br /> Signature of Owner/ContractodAulhor¢ed Agent Date �1� <br /> �°d✓a, ► <br />